在供肾来源极其短缺的情况下，扩大标准供者(ECD)供肾移植数量不断上升，其效果不如标准供者供肾移植且并发症较多，需要严格遵循"安全有效"和"知情同意"的伦理准则。一是由于目前国际上对ECD评估暂无统一标准，需要伦理委员会采用合理的方式方法充分审查，避免ECD供肾无原则滥用，以免受者经济、身体甚至生命安全受到严重损害。二是ECD供肾移植前应获得患者的知情同意，但患者知晓后很可能拒绝，从而导致ECD供肾移植无法开展。建议卫生行政部门联合中华医学会器官移植学分会拟定包含ECD供肾相关内容、有较强权威性和公信力的知情同意书统一使用，在尿毒症患者到移植中心初诊时即实施肾移植手术的知情告知，征求患者自由和充分的知情同意。

The application of kidney from expanded criteria donor(ECD) increases year by year because of a severe shortage of donor kidneys.The clinical effect of kidneys from ECD is not as good as those of standard criteria donor kidney transplantation and more complications were found after transplantation. So the ethical principles of safe and effective, and informed consent need to be strictly followed. Firstly, There is no uniform criterion for the evaluation of ECD around the world at present. So it is necessary for the ethics committee to adopt reasonable means to fully examine, avoiding to the abuse of kidneys from ECD and serious damage to the recipient′s economy, health and even life safety. Secondly, informed consent of recipients should be obtained for ECD donor kidney transplantation, but they are very likely to refuse to recieve transplantation after they know that, which eventually lead to the application of donor organs from ECD unable to be carried out. It is suggested that the health administrative department and the branch of organ transplantation of Chinese Medical Association should cooperation with each other to draw up an authoritative and credible informed consent letter containing the relevant contents of ECD donor kidney transplantation for unified use in transplantation centers. Informed notification should be given when uremic patients first visit the transplantation centers for their free and full informed consent.